You: Age 45 to about 57. Canadian citizen living in Vancouver, B.C., or willing to relocate there. Cancer patient or survivor. Open-minded. Bit of a risk taker. Warm hearted but not clinging. Bald OK.

It's not your typical posting of someone looking for a date. Granted, Jeanne Sather is looking for love and a best friend, according to this posting on her blog, assertivepatient.com. But what she was suggesting on the post was that she would like to marry a Canadian man so she could gain access to that country's publicly funded health-care system. . . .

She estimates more than half of what she receives monthly in disability and child support goes toward her $800-a-month health insurance premium, and is still only a portion of what it costs to treat her disease. She said treating her cancer, which has now spread to her bones, is about $300,000 a year. She said she pays more than $20,000 of that out-of-pocket.

ACS ResearchLink is an innovative project, created by the American Constitution Society for Law and Policy (ACS), designed to bridge the gap between the research papers law students must write and the needs of public interest lawyers. According to the ACS website, public interest lawyers need legal scholarship to assist them in assessing the strength of specific novel theories, but have limited time and resources. Law students must write substantial research papers that satisfy their schools’ writing requirements, but frequently struggle for appropriate and interesting topics. ACS ResearchLink answers the question: Why not give students the option of creating relevant and timely scholarship that will simultaneously serve the public interest? The interactive database allows lawyers to submit paper topics that students can search for ideas. After papers are written and graded under faculty supervision, they will be posted in the online library (the library should have its first papers in 2008). There are many paper ideas currently posted in the database from a range of organizations that include the ACLU, Lambda Legal Defense and Education Fund, various legal aid societies, and more. [JJ]

I suppose it should not come as a surprise but the FDA apparently has not been sufficiently protecting the interest of individuals who participate in clinical trials. The New York Times reports:

The Food and Drug Administration does very little to ensure the safety of the millions of people who participate in clinical trials, a federal investigator has found. In a report released Friday, the inspector general of the Department of Health and Human Services, Daniel R. Levinson, said federal health officials did not know how many clinical trials were being conducted, audited fewer than 1 percent of the testing sites and, on the rare occasions when inspectors did appear, generally showed up long after the tests had been completed.

The F.D.A. has 200 inspectors, some of whom audit clinical trials part time, to police an estimated 350,000 testing sites. Even when those inspectors found serious problems in human trials, top drug officials in Washington downgraded their findings 68 percent of the time, the report found. Among the remaining cases, the agency almost never followed up with inspections to determine whether the corrective actions that the agency demanded had occurred, the report found.

“In many ways, rats and mice get greater protection as research subjects in the United States than do humans,” said Arthur L. Caplan, chairman of the department of medical ethics at the University of Pennsylvania. Animal research centers have to register with the federal government, keep track of subject numbers, have unannounced spot inspections and address problems speedily or risk closing, none of which is true in human research, Mr. Caplan said.

The New York Times reports on the Senate's passage of the reauthorization of SCHIP. It states,

The Senate gave final approval on Thursday to a health insurance bill for 10 million children, clearing the measure for President Bush, who said he would veto it. The 67-29 vote followed a series of speeches by Republican senators supporting the bill and urging Mr. Bush to reconsider his veto threat. Senator Pat Roberts of Kansas, one of 18 Republicans who voted for the bill, said the White House had shown “little if any willingness to come to the negotiating table.”

Republican opponents of the bill, like Senators Judd Gregg of New Hampshire and John Cornyn of Texas, said it would be a big step toward socialized medicine, would shift people from private insurance to a public program and would allow coverage for illegal immigrants and children in high-income families. Senator Charles E. Grassley, Republican of Iowa, said it was “intellectually dishonest” to make such “outlandish accusations.” Mr. Bush has said the bill would move toward “government-run health care for every American.” Senator Bob Corker, Republican of Tennessee, said those fears were unfounded. “What will move our country toward socialized medicine is not this bill, which focuses on poor children, but the lack of action to allow people in need to have access to private affordable health care,” Mr. Corker said.

The bill would expand the State Children’s Health Insurance Program to cover nearly four million uninsured children, in addition to the 6.6 million already enrolled. It would provide $60 billion over the next five years, $35 billion more than the current spending and $30 billion more than the president proposed. Mr. Bush has not shown a willingness to compromise. But he may come under pressure so from Republican lawmakers who do not like being portrayed as hostile to children’s interests.

Democrats have selected Graeme Frost, 12, of Baltimore, to deliver their Saturday radio address. He will appeal to the president to sign the bill. . . . .

Should be an interesting weekend . . . Here is further coverage from NPR.

Law.com has a brief overview of the Warner-Lambert v. Kent, 06-1498 case recently granted cert. by the United States Supreme Court. It states,

The Supreme Court said Tuesday it will decide a case that centers on whether federal regulation of pharmaceuticals pre-empts state law. The case involves a product liability lawsuit against Pfizer's Warner-Lambert unit.

A group of Michigan plaintiffs led by Kimberly Kent in April 2000 sued Warner-Lambert Co. over alleged injuries caused by its Rezulin diabetes drug. Rezulin was ordered off the market in March 2000 by the Food and Drug Administration after it was linked to nearly 400 deaths and hundreds of cases of liver failure.

A federal district court dismissed the suit in 2005, citing a Michigan law that shields FDA-approved pharmaceuticals from liability lawsuits. The case was brought under Michigan law but was moved to federal court because other states were also involved.

An exception in Michigan's law that allowed the suits to proceed if a pharmaceutical company misrepresents information presented to the FDA was pre-empted by federal laws governing the regulation of pharmaceuticals, the district court said.

The 2nd U.S. Circuit Court of Appeals, based in New York, reinstated the suit. The appeals court disagreed that the exception in Michigan's law for cases involving fraud against the FDA was pre-empted by federal law. That decision conflicted with other appeals court rulings in previous cases. Such conflicts in the federal appeals courts are one criterion the justices consider when deciding to take a case.

The Supreme Court's interest in weighing in on the federal pre-emption of state laws is rooted in a surge of product liability lawsuits in state courts, "particularly in the area of drugs and medical devices," said Paul Smith, an attorney at Jenner & Block.

http://pandagon.blogsome.com/Salon.com's Robert Burton has an interesting piece highlighting a recent study in the Archives of Neurology that a woman in a persistant vegetative state was "aware of herself and her surroundings." The article states,

In a recent article in the Archives of Neurology, a team of British and Belgian neuroscientists describe a clinically unconscious accident victim who can, on command, imagine herself playing tennis and walking around her house. By showing that her functional brain imaging studies (fMRI) are indistinguishable from those of healthy volunteers performing the same mental tasks, the researchers claim that the young woman's fMRI "confirmed beyond any doubt that she was consciously aware of herself and her surroundings, and was willfully following instructions given to her, despite her diagnosis of a vegetative state."

Their extraordinary conclusions are beyond provocative; they raise profound questions about the very notion of consciousness. What's more, they could throw thousands of families and doctors into utter turmoil. As with the Terri Schiavo controversy, patient advocacy groups, self-serving lawyers and politicians with personal agendas could use the study's stamp of certainty as a given.

Yet the study's conclusions are not beyond a doubt. There are plenty of questions about whether this young woman is conscious and capable of choice.

Amanda Marcotte at Pandagon responds to Burton's analysis of the study. She finds his concern that the Schiavo case and others involving PVS patients will be more problematic in the future. She writes,

Myth #1: The decision whether or not to terminate life support was about Schiavo’s specific condition.

Their extraordinary conclusions are beyond provocative; they raise profound questions about the very notion of consciousness. What’s more, they could throw thousands of families and doctors into utter turmoil. As with the Terri Schiavo controversy, patient advocacy groups, self-serving lawyers and politicians with personal agendas could use the study’s stamp of certainty as a given.

Burton doesn’t state that directly, but his statement here about how this study could “influence” the landscape invokes the anti-choice myth that this is about a very specific, unique circumstance in medicine, and it’s not really. The case was decided on two merits: Who has the final decision-making capabilities for the patient on life support and what were the patient’s wishes about the situation. The main relevance of her condition was whether or not she was far gone enough to put the decision to terminate in the family’s hands; but that fact wasn’t really up for dispute anymore. The real axis was whether or not

She clearly is not a supporter of Ms. Schiavo's parents. She has further thoughts on the study and Burton's analysis here (warning - some strong language). (I could not link directly to her post so you will need to scroll down a bit to find it. The Post is entitled, "Brain Flickers v. Who Decides").

Emptywheel at the Next Hurrah ponders the question of what it will mean for health care in the United States when Unions begin to act as major purchaser of health care. Her commenters are not expecting much difference between GM and the Union in terms of bargaining power. She writes:

The UAW is about to become one of the country's biggest purchasers of health care.

Under the agreement, responsibility for the retiree health plan will shift to a Voluntary Employees' Beneficiary Association managed by the union. Details about how the VEBA will be funded have not been disclosed. But it is expected to involve a one-time payment of as much as $35 billion by GM, providing the union with money to invest and use to pay for retiree benefits while reducing the company's future expenses by billions of dollars. Creation of the retiree health trust is to be monitored by a judge and the Securities and Exchange Commission, according to GM's statement this morning.

At a Detroit news conference, UAW president Ronald A. Gettelfinger said the memorandum of understanding outlining the health fund would secure retiree health benefits for decades to come. . . . I'm especially intrigued by the possibilities of unions exerting a lot of sway in the health care industry. As the UAW becomes a bigger and bigger buyer, for example, they're going to be able to demand price reductions. Which means they might be able to offer affordable health care to unaffiliated workers who join the union.

ThinkProgress reports on the passage of the re-authorization for SCHIP in the House of Representatives. It states,

An overwhelming bipartisan majority in the House voted 265-159 tonight to pass the popular and successful Children’s Health Insurance Program Reauthorization Act. The support fell just short of the two-thirds majority needed to override Bush’s expected veto of the bill. Speaker Pelosi called on Bush to “dig deeply into his heart” before depriving millions of children of health insurance:

I’m reminded of the Bible tonight, and I speak with all of the sincerity and all of the hope to President Bush in the hope that he will change his mind. To dig deeply into his heart and think about the children in America who don’t have healthcare. Because if not, I think that the President is giving new meaning to the words, ’suffer, little children.’ Suffer, little children, if your parents can’t afford health insurance.

The Associated Press reports on the idea that employers should pay employees to lose weight to save on health care costs. Apparently people do respond to such a financial stimulus. The AP states,

People will lose weight for money, even a little money, suggests a study that offers another option for employers looking for ways to cut health-care costs. The research published in the September issue of the Journal of Occupational and Environmental Medicine found that cash incentives can be a success even when the payout is as little as $7 for dropping just a few pounds in three months.

Unlike providing onsite fitness centers or improving offerings in the company cafeteria, cash rewards provide a company with a guaranteed return, the researchers said. "They really can't be a bad investment because you don't pay people unless they lose weight," said Eric A. Finkelstein, the study's lead author and a health economist at RTI International, a research institute based in nearby Research Triangle Park.

The study involved about 200 overweight employees at several colleges in North Carolina. One group received no incentives while two other groups received $7 or $14 for each percentage point of weight lost. Participants didn't get any help. Employees who received the most incentives lost the most weight, an average of almost 5 pounds after three months. Those offered no incentives lost 2 pounds; those in the $7 group lost about 3 pounds.

Finkelstein and co-authors Laura Linnan and Deborah Tate, professors at the University of North Carolina at Chapel Hill's School of Public Health, are analyzing data from a follow-up study that observed about 1,000 participants for a year. . . .

For those of you in the New York, New Jersey area, Professor Kevin Outterson, Boston University School of Law and Merck Visiting Scholar, will be speaking tomorrow evening at 6pm at the Seton Hall Law School. His talk is entitled, "Putting Patients First: Access to HPV Vaccines for Low- and Middle-Income Populations."

The HPV vaccine holds the promise to help dramatically reduce cervical cancer but remains out-of-reach for numerous women across the world due to its costs. Professor Outterson will address the issue of access to the life-saving vaccine and examine ways in which pharmaceutical companies and governments can support both access and innovation. More about his presentation here. It should be a great talk and provides information on a topic that often gets overlooked in the excitement over a new vaccine.

Today's Diane Rehm show has an interesting discussion on the reauthorization of SCHIP. It provides some lively analysis of the debate over the expansion of the program and the President's threatened veto. Here is the write-up for the program:

A popular children's health insurance program expires September 30th. The House and Senate have worked out a deal to reauthorize it. Two experts, a journalist and a U.S. Senator will discuss the deal on the State Children's Health Insurance Program (SCHIP)

Guests

Robert Greenstein, founder and executive director of the Center on Budget and Policy Priorities

Jonathan Weisman, reporter, "The Washington Post"

Nina Owcharenko, Senior Policy Analyst in the Center for Health Policy Studies at the Heritage Foundation

The New York Times reports on private investors purchasing nursing homes. What has been the result of the change in ownership -- well - according to the Times research - not good.

Regulators say residents at these homes have suffered. At facilities owned by private investment firms, residents on average have fared more poorly than occupants of other homes in common problems like depression, loss of mobility and loss of ability to dress and bathe themselves, according to data collected by the Centers for Medicare and Medicaid Services.

The typical nursing home acquired by a large investment company before 2006 scored worse than national rates in 12 of 14 indicators that regulators use to track ailments of long-term residents. Those ailments include bedsores and easily preventable infections, as well as the need to be restrained. Before they were acquired by private investors, many of those homes scored at or above national averages in similar measurements.

In the past, residents’ families often responded to such declines in care by suing, and regulators levied heavy fines against nursing home chains where understaffing led to lapses in care. But private investment companies have made it very difficult for plaintiffs to succeed in court and for regulators to levy chainwide fines by creating complex corporate structures that obscure who controls their nursing homes. By contrast, publicly owned nursing home chains are essentially required to disclose who controls their facilities in securities filings and other regulatory documents.

The Byzantine structures established at homes owned by private investment firms also make it harder for regulators to know if one company is responsible for multiple centers. And the structures help managers bypass rules that require them to report when they, in effect, pay themselves from programs like Medicare and Medicaid. Investors in these homes say such structures are common in other businesses and have helped them revive an industry that was on the brink of widespread bankruptcy. “Lawyers were convincing nursing home residents to sue over almost anything,” said Arnold M. Whitman, a principal with the fund that bought Habana in 2002, Formation Properties I. Homes were closing because of ballooning litigation costs, he said. So investors like Mr. Whitman created corporate structures that insulated them from costly lawsuits, according to his company. “We should be recognized for supporting this industry when almost everyone else was running away,” Mr. Whitman said in an interview. . . .

The Times’s analysis of records collected by the Centers for Medicare and Medicaid Services reveals that at 60 percent of homes bought by large private equity groups from 2000 to 2006, managers have cut the number of clinical registered nurses, sometimes far below levels required by law. (At 19 percent of those homes, staffing has remained relatively constant, though often below national averages. At 21 percent, staffing rose significantly, though even those homes were typically below national averages.) During that period, staffing at many of the nation’s other homes has fallen much less or grown.

Nurses are often residents’ primary medical providers. In 2002, the Department of Health and Human Services said most nursing home residents needed at least 1.3 hours of care a day from a registered or licensed practical nurse. The average home was close to meeting that standard last year, according to data. But homes owned by large investment companies typically provided only one hour of care a day, according to The Times’s analysis of records collected by the Centers for Medicare and Medicaid Services.

TalkLeft has a great discussion about this takeover and what it means for individuals considering long-term care for their loved ones.

Law.com reports on an increasing number of lawsuits against health insurers for post-claims unwriting (canceling policies on discovery of alleged inaccuracies in initial application) and discusses briefly an upcoming California case that could help clarify the law.

William Shernoff says he has been bringing lawsuits over canceled health insurance policies since the 1980s. Lately, however, that part of the Southern California plaintiff lawyer's practice has exploded: Last year, Shernoff filed about 70 lawsuits for people who have gotten stuck with hefty medical bills when an insurance company revoked their coverage by claiming they falsified or omitted important details on their applications. He's on pace to file about the same number this year. So far, Shernoff says, litigation over the insurance companies' practice -- often referred to as post-claims underwriting -- hasn't led to any significant case law. . . . .

But next week, the Santa Ana, Calif.-based 4th District Court of Appeal will hear arguments in a closely watched case that challenges Blue Shield of California's practice of rescinding coverage based on inaccuracies in an application. If the challenge in Hailey v. California Physicians' Service, G035579, succeeds, plaintiff and defense lawyers say more cases may wind up in trial -- or lead to more lucrative settlements.

According to Michael Nutter, a Santa Ana solo representing the plaintiffs, Steven Hailey suffered a catastrophic car accident shortly after he and his wife enrolled in a health plan. When Blue Shield rescinded his policy, Hailey had to sign up with a new insurer and wait six months for surgery with a torn urethra and other injuries, Nutter said.

In court papers, attorneys for Blue Shield claim that Hailey lied on his application about his weight and concealed information about a recent hospital visit and a host of medical conditions. More broadly, Blue Shield argues (.pdf) it can rescind coverage when someone's made a misrepresentation material to the company's decision to offer them a health plan.

Central to the case is California Health and Safety Code §1389.3: It suggests health care plans are responsible for resolving all reasonable questions about an application before entering into a contract, and generally prohibits post-claims underwriting. But it also expressly says it does "not limit a plan's remedies upon a showing of willful misrepresentation."

Plaintiff attorneys in the field contend (.pdf) that a showing of willful misrepresentation is required before yanking coverage; defense attorneys say the mention of willful misrepresentation does not amount to a prerequisite. . . . If the 4th District requires a showing of willful misrepresentation, health insurers will likely find it harder to get cases thrown out early. "Even if the plaintiff's excuse was unbelievable, you might have some judges say, 'Well, let's have a jury deal with that,'" Pimstone said. Shernoff, of Claremont's Shernoff Bidart Darras, would jump at the chance to take other claims before a jury. In an amicus curiae brief filed in the Hailey case, Shernoff claims that Blue Shield has rescinded many members' coverage without investigating whether they intended to deceive the company. "That means all the past decisions could have been in bad faith," he said, which could provide grounds for punitive damages.

The Government Executive.com website discusses recent visits from the new OMB Director Jim Nussle to Congress concerning the SCHIP program and a vote to re-authorize it.

President Bush has threatened to veto emerging State Children's Health Insurance Program legislation and appropriations bills that are $23 billion over his fiscal 2008 budget request. Even as he was starting meetings with key Democratic leaders and members of the Appropriations and Budget committees this week, Nussle, the former House Budget chairman, made it clear that he is not about to give ground on Bush's demands. . . .

Nussle lambasted the outlines of SCHIP legislation Democrats hope to send to Bush's desk by the end of the month as "veto-bait" and a "political strategy" to paint the administration as insensitive to low-income children more than a serious effort to renew the program.

"What they're doing is choosing political strategy over kids ... they can't get their work done, so they're going to send up something that they know is veto bait," Nussle said. "Everyone knows that; it's been as telegraphed as just about anything around here." From a philosophical standpoint, Nussle rejected the proposed expansion of SCHIP and efforts to finance it through a cigarette tax increase.

"I think it will end up basically being the first big tax increase on the part of the Congress, and the president's been clear on that. So here we have another situation where we had an opportunity to improve a program that had unsustainable growth, and that was serving people outside of its ... original intent, and actually causing, potentially causing, people who were already under private insurance to potentially shift to government-run insurance, and that seems to be counter to everyone's intent," Nussle said. "So we'll have to look at it. But at this point in time, it looks more like a political strategy in search of a potential solution."

Democrats Monday answered Bush's veto threats by pointing to his 2004 campaign, saying he promised to enroll more children eligible for health insurance. In a floor speech, Senate Majority Leader Harry Reid, D-Nev., pointed to the bipartisan support for the Senate bill and said the Senate "will not be intimidated by the president's veto threats." A spokesman for House Speaker Nancy Pelosi, D-Calif., noted that all but three Republicans supported the proposed cigarette tax increase in the House version as part of a GOP motion to recommit, and that the majority of the bill's $272 billion, 10-year cost was financed by Medicare spending cuts. "We will get a bipartisan bill to the president that insures millions more children, that is fully paid for and does not increase the deficit. For the sake of America's children, we hope the president will sign it," said Pelosi spokesman Nadeam Elshami.

The stalemate over SCHIP mirrors that over fiscal 2008 appropriations, as none of the 12 annual spending bills are likely to make it to Bush's desk in time for the end of the fiscal year on Sept. 30. That means an interim continuing resolution will be necessary to fund government operations, as will a short-term extension of the expiring SCHIP.

The Washington Post reports further that it isn't just the Democrats in Congress who favor this bill. In today's paper, it states,

Republicans reacted angrily yesterday to President Bush's promise to veto a bill that would renew and expand the popular State Children's Health Insurance Program, raising the likelihood of significant GOP defections when the package comes to a vote next week.

"I'm disappointed by the president's comments," said Sen. Charles E. Grassley (R-Iowa), who urged Bush, in an early-morning telephone conversation yesterday, to support the emerging bipartisan compromise. "Drawing lines in the sand at this stage isn't constructive. . . . I wish he would engage Congress in a bill that he could sign instead of threatening a veto."

Forget those old debates over embryonic stem cells -- Daily Kos points to an interesting article concerning a new scientific discovery conerning stem cells. The Globe and Mail reports,

Men have a source of potentially life-saving stem cells between their legs.

A team of American researchers has found a way to easily identify stem cells in the testicles of adult mice that can be coaxed to turn into brain cells, muscle cells, heart cells, blood cells and even blood vessels.

One day, they say, male patients may be able to turn to their own testicles as a source of stem cells to repair an ailing heart or kidney or to fix the brain damage caused by Alzheimer's or Parkinson's disease.

The procedure would involve removing a small piece of testicle - about the same amount used for a biopsy. "We don't need a lot of material," says Marco Seandel, the lead author of a paper to be published today in the journal Nature and a stem cell researcher at the Howard Hughes Medical Institute in Maryland.

His team's work - and that of a German team also experimenting with stem cells extracted from testicles - is part of a growing international effort to look beyond the embryo for cells that can give rise to all human body parts and systems.

I have to agree with the editors at DailyKos who write, "Rarely has any medical breaththrough offered so many potential benefits to the population, while also providing such bounty to late night commedians."

After several years of shortages, this year there is plenty of flu vaccine for everyone. Time Magazine reports the CDCs effort to encourage individuals to take advantage of the new supply:

The ample supplies have the government urging vaccinations not just for people at highest risk of dying from influenza, but for anyone who wants to avoid a week of aching misery.

"Flu is a formidable foe," Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention, said Wednesday. "It is not an illness we should be complacent about."

But new CDC data show only a fraction of people who need flu shots the most get them, including just one in five babies and toddlers. And there's wide geographic variation, with Rhode Island reporting the most high-risk adults vaccinated and Nevada the fewest.

Shots aren't the only option. Wednesday, the government ruled that it's safe for younger kids than ever before to try a nasal-spray vaccine called FluMist. Once only an option for people ages 5 to 49, FluMist now can be used by children as young as 2.

This week's Journal of the American Medical Association contains a brief article discussing the adoption of palliative care by hospitals. The article provides a concise definition and overview of the history of palliative care. It states in part,

Despite advances in medicine and medical technology, there isa growing population of aging patients with complex health problemswho are poorly served by even the best intensive care units.To help these patients, who often have multiple chronic conditionsor various complications of acute conditions, hospitals areturning to palliative care, which focuses on symptom management,communication, and other means to improve quality of life forpatients and their families.

Palliative care may be delivered in concert with curative or life-prolonging medical care and is not prognosis dependent. These features distinguish it from hospice care, which offers symptom management for patients who are facing a terminal illness and no longer wish to undergo life-prolonging treatments, as well as other kinds of support for these patients and their families.

Between 2000 and 2005, the number of hospitals with palliativecare programs grew by 96% from 632 to 1240, according to theCenter to Advance Palliative Care, which analyzed data fromthe 2007 American Hospital Association Annual Survey of Hospitals.

The field of palliative and hospice care became formally recognizedas a subspecialty by the American Board of Medical Specialtiesin 2006. A record 10 specialty groups—anesthesiology,emergency medicine, family medicine, obstetrics and gynecology,internal medicine, pediatrics, physical medicine and rehabilitation,psychiatry and neurology, radiology, andsurgery—endorsehospice and palliative medicine as a subspecialty of their fields.

The LaTimes recently ran this amazing and inspirational story about Professor Elyn Saks discussing her new book concerning her Schizophrenia. The article reports,

Saks has schizophrenia, a severe mental disorder often characterized by social isolation, disorganized speech, delusions and hallucinations. She has defied the prediction of a doctor who once said she would never lead an independent life. She has even flourished, thanks to a strict regimen of medication and talk therapy.

Now she wants to dash the myths surrounding an illness that affects 3 million Americans: Schizophrenics aren't all emotionally out of touch, shouting and swiping at gremlins, shut away in hospitals. Like her, some lead productive lives with good friends, loving spouses and precious emotional triumphs.

At 51, Saks says, the time has come to reveal her secret. The San Francisco speech was one of her first major public forays.

Like the story of fellow schizophrenic John Forbes Nash, the Nobel Prize-winning economist and mathematician whose life was portrayed in the book and film "A Beautiful Mind," Saks' life illustrates not only the stresses mental illness places on personal and professional relationships but also how they can be overcome. . . .

On Aug. 14, Saks' memoir, "The Center Cannot Hold: My Journey Through Madness," was published. The secret was out.

As she prepared to address the American Psychological Assn. convention, Saks fidgeted.

"I'm nervous," she said.

Her book had received positive reviews. But there were hints of negativity: One USC worker told Saks she would have never gone to dinner with her had she known of her schizophrenia, afraid that one of Saks' delusional episodes could occur at any time.

Saks was speaking to her first large audience since her memoir had been published. She was never comfortable with public speaking, and her hands shook visibly as she took the podium, introduced by her old friend Steve Behnke.

When she finished, a lone woman rose to her feet, followed by more audience members. Quickly, the entire crowd was standing. The applause was prolonged and emotional as listeners lined up to speak with her.

My apologies for not posting these events sooner. If you are in New York or Chicago tomorrow, you have a wonderful opportunity to attend an interesting and educational health law event.

DePaul University College of Law, its Health Law Institute, Center for Intellectual Property Law & Information Tehcnology Center for Public Interest Law and International Human Rights Law Institute and Doctors without Borders, present "Intellectual Property and Access to Medicines in the Developing World."

The program runs from 3-5pm tomorrow at the DePaul Center Room 8805, One East Jackson Boulevard, Chicago. More information is available here.

Brooklyn Law School and its Center for Health, Science and Public Policy and the ABA Antitrust Section Committee on Health Care and Pharmaceuticals present, "Balancing Competition and Goverment Allocation of Health Care Resources: The Berger Commission Report."

The program runs from 9am-12:3pm, at Brooklyn Law School, Subotnick Center 250 Joralemon Street, Brooklyn, New York. More information is available here.